---
title: UnitedHealthcare Community Plan of Florida ABA / BA coverage (MMA plan).
url: "https://carelu.com/payers/unitedhealthcare-community-plan-florida"
markdown_url: "https://carelu.com/payers/unitedhealthcare-community-plan-florida.md"
state: FL (Florida)
payer: UnitedHealthcare Community Plan of Florida
kind: Medicaid managed care plan (MCO)
parent_program: Florida Medicaid (AHCA)
description: "How UnitedHealthcare Community Plan administers Florida Medicaid Behavior Analysis — Optum's portal-only Provider Express workflow, the two-step assessment/treatment authorization, 120-day carve-in continuity, and claims mechanics (payer ID 87726)."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# UnitedHealthcare Community Plan of Florida ABA / BA coverage (MMA plan).

_Payer Guide · UHC Community Plan (FL) · Last updated September 2026 · 3 primary sources_

> Optum-run since 2/2025: portal-only PA on Provider Express, 2-step auth, 120-day continuity.

UnitedHealthcare Community Plan of Florida handed its Behavior Analysis program to Optum (United Behavioral Health) at the February 1, 2025 carve-in — making it the most "national-carrier" experience of the nine MMA plans. Authorizations run Optum's standard two-step structure on Provider Express, and uniquely among Florida's plans, the pathway is portal-only: no fax route is advertised for BA auths. The AHCA coverage policy remains the clinical floor and ceiling per the state contract, but the day-to-day machinery — clinical criteria documents, portal, credentialing — is Optum's ABA stack.

This plan administers the **Florida Medicaid (AHCA)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — portal-only via Provider Express ("ABA Assessment" request type); no fax pathway advertised [1]
- **Prior auth for treatment**: Required — "ABA Treatment" request type; Optum's two-step assessment-then-treatment structure [1]
- **Autism diagnosis required?**: No — state BA policy applies: physician referral + order + CDE, no autism-diagnosis requirement [1][3]

## At a glance

- **Plan type:** SMMC MMA plan; BA program managed by Optum since 2/1/2025
- **Clinical rules:** AHCA BA policy (state floor/ceiling) + Optum criteria (BH803ABA + FL supplement)
- **Prior auth:** Portal-only — Provider Express, "ABA Assessment" then "ABA Treatment"
- **Continuity at carve-in:** 120 days honoring Acentra auths; non-par paid at prior rates ≥60 days
- **Claims:** Payer ID 87726; 180-day timely filing; clean claims in 15 calendar days
- **Support:** Web support 1-866-209-9320; provider services 1-877-614-0484

## The Optum workflow on a state-policy base

All BA services require prior authorization, and requests must be submitted via the secure Provider Express portal (One Healthcare ID login): Auths → Request a new authorization → select "ABA Assessment" or "ABA Treatment" from the dropdown. That two-step, assessment-then-treatment structure is Optum's national ABA pattern, applied to the Florida Medicaid population — with the state contract requiring compliance with the AHCA coverage policy, so the referral + order + CDE gate, the no-autism-diagnosis eligibility, and the state documentation stack all still apply. There is no advertised fax pathway for BA auths, which makes portal access a day-one credentialing task for any practice taking UHC members. Optum's Gold Card program can waive PA for eligible network behavioral providers — worth asking about once a track record exists. [1]

## Transition history and claims mechanics

At the carve-in, UHC committed to a 120-day continuity-of-care period from February 1, 2025 — honoring and extending existing Acentra authorizations for the full 120 days and paying non-participating providers at prior rates for a minimum of 60 days. That window has closed; every auth now lives in Provider Express. Claims go to UHC Community Plan under payer ID 87726 with 180-day timely filing, and clean claims process within 15 calendar days. First-time submitters must include a W9 and a copy of the Florida license with the claim — a known first-claim tripwire for groups new to the plan. [1]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare Community Plan of Florida, and what they have to bring.

- **Age limit**: Follows the Florida Medicaid rule: BA is for recipients under the age of 21, with EPSDT available above the policy and fee-schedule limits. The plan’s SMMC Behavioral Analysis Program quick reference guide and Optum’s Florida ABA QRG are both administrative — continuity of care, portal navigation, claims, payment — and publish no clinical criteria, including no age criterion. [3][1][2]
- **Diagnosis recency**: No autism diagnosis is required. The state cycle governs: reassessment and an updated behavior plan at least every six months to renew, with the Vineland-3 and BASC-3 PRQ core instruments re-administered every 12 months, and no maximum age on the Comprehensive Diagnostic Evaluation itself. Neither the plan QRG nor Optum’s Florida ABA QRG publishes a Florida-specific recency window. [3][1][2]
- **Who may diagnose**: The state rule, unchanged: the referral comes from an independent physician or qualifying practitioner (PCP in family practice, internal medicine or pediatrics; a developmental-behavioral, neurodevelopmental, pediatric-neurology or adult/child-psychiatry specialist; or a child psychologist), and the CDE must be led by a licensed practitioner working within their medical, developmental or psychological scope of practice. Optum’s national ABA criteria — which require a DSM-5-TR diagnosis from a state-licensed physician, psychologist or other qualified state-licensed clinician — are the commercial pattern, not the Florida Medicaid gate, and the state contract makes the AHCA policy the floor and ceiling. [3][1]
- **Diagnostic tools required**: The state pair: Vineland-3 Comprehensive Parent Interview Form for all recipients (plus the Maladaptive Behavior Domain for ages 3 and older) and the BASC-3 PRQ for ages 2 through 18, with the complete scoring reports submitted with every prior-authorization request. Additional tools are at the Lead Analyst’s discretion. Neither the plan QRG nor Optum’s Florida ABA QRG adds an instrument requirement. [3][1][2]
- **Referral required?**: Required — the state gate (independent physician referral, physician’s order for BA services, and a CDE performed to national evidence-based practice standards) applies unchanged. What is UHC-specific is the channel, not the content: “all behavioral analysis services require prior authorization. Requests must be submitted via the secure portal” — Provider Express, Auths, Request a new authorization, then “ABA Assessment” or “ABA Treatment” from the dropdown. No fax pathway is advertised for BA, which makes One Healthcare ID and Provider Express registration a day-one task rather than a fallback. [1][3]
- **Telehealth**: Follows the Florida Medicaid rule: the only telemedicine provision is up to two hours per week of Lead Analyst caregiver training (97156) under Rule 59G-1.057, F.A.C. Neither the plan’s SMMC Behavioral Analysis Program QRG nor Optum’s Florida ABA QRG publishes a telehealth code list, place-of-service rule or modifier set for Florida Medicaid BA, and Optum’s national supplemental criteria treat telehealth as a best-practice reference rather than a coded benefit. [3][1][2]
  - Ask the plan: Optum Behavioral Health provider services (1-877-614-0484) before scheduling any remote BA session other than 97156 caregiver training.
- **Prior-auth decision time**: UHC’s 2026 Florida Medicaid manual lists non-urgent pre-service decisions “within 7 days of receipt of request” and urgent/expedited pre-service decisions “within 2 days of request receipt.” Retrospective reviews take 30 calendar days from receipt of all clinical information. BA requests go through Optum (Provider Express), and neither the manual nor the Optum BA quick reference guide publishes a reauthorization lead time. Note the gap with the AHCA contract, which requires standard decisions “within no more than five (5) days following receipt” for MMA plans. The plan’s published 7 days is the realistic planning number. [4][5]
- **Other insurance (who pays first)**: UHC’s manual: “UnitedHealthcare Community Plan is, by law, the payer of last resort for eligible members. Therefore, you must bill and obtain an explanation of benefits (EOB) from any other insurance or health care coverage resource before billing.” Attach the complete EOB, showing the paid amount or denial reason, to the UHC claim. Optum’s BA quick reference guide warns that claims needing “an exception process, such as coordination of benefits (COB)” may fall outside the usual 15-calendar-day processing time. It does not say whether an Optum BA authorization is still needed when a commercial plan is primary. Florida Medicaid pays last. Rule 59G-1.052 says: “Florida Medicaid is the payer of last resort. Providers must exhaust all TPL sources of payment, such as Medicare, TRICARE, private health insurance … prior to submitting or resubmitting a claim.” The AHCA contract binds every MMA plan to that rule. Two consequences for intake: Medicaid pays only “the difference between the Florida Medicaid rate and the third-party payment,” and it pays nothing when “the provider’s TPL claim is denied for failing to obtain the appropriate authorization from the third-party.” So get the commercial plan’s own ABA authorization first. [4][1][6]
  - Ask the plan: Optum / UHC Community Plan Provider Services: whether an Optum BA authorization is required when a commercial plan pays first.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare Community Plan of Florida pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: The state floor: supervision of BCaBAs and RBTs follows the Council of Autism Service Providers practice standards as set out in the supervision plan inside the approved behavior plan, which must name the authorized supervisors; a Lead Analyst is a BCBA, FL-CBA or Ch. 490/491 licensee, a BCaBA works under a BCBA, and an RBT under a BCBA or BCaBA. Optum’s Florida BA materials publish no ratio or caseload cap, and Optum’s Gold Card program can waive prior authorization for eligible network behavioral providers once a track record exists. [3][1]
- **Session-note signature**: The state rule: “session notes must be signed and dated by the rendering practitioner,” carrying date, time, location and duration, behaviors observed, skills targeted, the recipient’s response, protocol modifications and therapist directions, an explanation if the parent or guardian was absent, and the participants. The behavior assessment and behavior plan are signed by the Lead Analyst and the parent or guardian. Optum’s Florida BA materials add no signature rule. [3][1]
- **Place of service**: The state rule: a school-based request must carry the IEP, or a 504 plan, or documentation naming the school and explaining that neither is available; 1:1 shadow, personal care assistance, companion and chaperone services are non-covered “regardless of activity or setting,” as are caregiver/childcare services and travel time. Optum’s Florida BA materials publish no place-of-service code list for this plan. [3]
  - Ask the plan: Optum Behavioral Health provider services for whether the Florida Medicaid line expects a POS code set beyond what the state policy requires.
- **Bill as provider**: Claims go to UnitedHealthcare Community Plan under payer ID 87726 within 180 days of the date of service, on EDI 837P/CMS-1500 (or 837I/UB-04), with clean claims “processed within 15 calendar days after receipt.” A first-time submitter must include a W9 — the March 2025 edition of the plan QRG also required a copy of the Florida license with that first claim. Underneath, the state enrollment structure governs whose NPI can render: Lead Analyst 392, BCaBA 391, RBT 390, with 390s and 391s enrollable only inside an enrolled BA group (393). Payment is electronic only, by ACH via Optum Pay or virtual card. [1][2][3]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published for this plan. Optum’s commercial ABA reimbursement policy does permit 97153 and 97155 concurrently when two different providers render them, but it is a commercial policy and does not govern the Florida Medicaid line; the state rule that does govern is the opposite default — the supervisee is not reimbursed when the supervisor is reimbursed for the same time period, and simultaneous services by more than one BA provider are non-covered unless medically necessary, prior authorized and indicated in the approved behavior plan. [3]
  - Ask the plan: Optum Behavioral Health provider services (1-877-614-0484) — ask specifically whether the commercial concurrency rule is applied to UnitedHealthcare Community Plan of Florida BA claims, or whether the AHCA rule stands alone.

## What intake should collect for UnitedHealthcare Community Plan of Florida

- **Provider Express access:** Portal-only PA — confirm One Healthcare ID and Provider Express registration before the first UHC member.
- **Referral + order + CDE:** The state eligibility gate applies; no autism diagnosis required.
- **Vineland-3 & BASC-3 scoring reports:** The state documentation stack attaches to Optum requests too.
- **First-claim documents:** W9 + Florida license copy required with a first-time claim submission.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How UnitedHealthcare Community Plan of Florida ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** 87726
- **Behavioral health administrator:** Optum Behavioral Health
- **BH administrator payer ID:** 87726
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required | 24 units per initial behavior assessment (max); the reassessment variant, billed with modifier TS, caps at 18 units — same $19.05/unit rate either way. per per assessment/reassessment (not daily) — a new authorization is required each time, not a recurring daily allotment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | TS — reassessment variant, same $19.05 rate, separate 18-unit cap (vs. 24 for the initial assessment) |
| 97152 | Yes | Required | 8 units per assessment (max). per per assessment (not daily). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 97153 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week (≈160 units/week) BA-intervention cap set by the coverage policy §4.2.2. per week (aggregate across all treatment codes together, not per-code). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | XP — concurrent-supervision supervisee line, not separately reimbursed (the supervisor bills 97153/97155/97155-HN instead) |
| 97154 | Yes | Required | Max 6 participants per group (coverage policy §4.2.2); the group also counts toward the aggregate 40 hrs/week cap. Rendered by Lead Analyst, BCaBA, or RBT. per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $7.58/unit), UP (3 clients, $7.08/unit), UQ (4 clients, $6.58/unit), UR (5 clients, $6.08/unit), US (6 clients, $5.58/unit) |
| 97155 | Yes | Required | No code-specific unit cap on the fee schedule; counts toward the aggregate 40 hrs/week cap. per week (aggregate across all treatment codes). | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | HN — BCaBA tier, $15.37/unit (vs. $19.17 Lead Analyst base rate), XP — concurrent-supervision supervisee line, not separately reimbursed |
| 97156 | Yes | Required | No code-specific cap on direct/in-person units; the TELEHEALTH variant (GT modifier) is separately capped at 2 hrs/week (8 units/week). per week (telehealth portion); aggregate 40 hrs/week cap governs the rest. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | Yes — the ONLY Florida Medicaid BA code with a confirmed telehealth allowance. GT modifier, up to 2 hrs/week, per Rule 59G-1.057, F.A.C. (coverage policy §4.2.2, FL.CP.BH.500). Not confirmed whether the telehealth allowance extends to BCaBA-rendered (HN-modifier) training — both the coverage policy and Sunshine's clinical policy name the "Lead Analyst" specifically. Separately: Sunshine's general (non-BA) telehealth billing notice instructs POS 02 with NO GT/95/CR modifier appended, which appears to conflict with the BA-specific GT-modifier requirement — an unresolved discrepancy, flagged rather than guessed at; confirm the correct billing combination with each plan before submitting a 97156 telehealth claim. | GT — telemedicine delivery, same $19.05 rate, capped at 2 hrs/wk, HN — BCaBA tier, $15.24/unit (vs. $19.05 Lead Analyst base rate) |
| 97157 | No — absent from both the 2025 and 2026 AHCA Behavior Analysis fee schedules and not listed among the covered service categories in the Dec 2024 coverage policy §4.2.2. Cross-confirmed absent from Sunshine Health's own coding table (FL.CP.BH.500) and Humana's Florida Medicaid PA list too — three independent primary sources agree on the omission. This is NOT a formal written exclusion statement (no document states "97157 is excluded"), so treat this as verified-absent-from-the-billable-set rather than a proven-impossible claim. | N/A — not on the state's billable BA code set per the fee schedule and PA lists reviewed. | N/A per N/A | — | N/A | — |
| 97158 | Yes | Required | Max 6 participants per group; rendered by Lead Analyst or BCaBA only (NOT RBT, per the coverage policy — contrast 97154, which RBTs can render). per week (aggregate) plus a 6-participant group-size ceiling. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | UN (2 clients, $9.58/unit), UP (3 clients, $9.08/unit), UQ (4 clients, $8.58/unit), UR (5 clients, $8.08/unit), US (6 clients, $7.58/unit) |
| 0362T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol per the coverage policy. | 16 units per initial assessment or reassessment (max). per per assessment/reassessment. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |
| 0373T | Yes | Required, and conditioned on medical necessity for the extra-technician protocol. | No distinct unit cap beyond the underlying code's session limits — the fee schedule doesn't publish one separately for this add-on. | home (categorical — no CMS POS-code number published anywhere in FL BA documentation, state or plan level), office/clinic (categorical), school (categorical — IEP/504 plan, or a documented explanation, required with the PA request per the coverage policy §7.2), community/other (categorical, per plan PA-form checkboxes) | No — not authorized for this code under the AHCA BA Coverage Policy. Only 97156 (family/caregiver training) has a stated telehealth allowance in Florida Medicaid BA; every other code is telehealth:'No' by policy design, not by omission. | — |

Code notes:

- **97151:** Physician referral + order + Comprehensive Diagnostic Evaluation gate the very first assessment request (no autism-diagnosis requirement) — see the guide's prose for the intake sequence. Optum manages utilization review/PA for this program (two-step 'ABA Assessment' then 'ABA Treatment' request types on Provider Express), but claims still bill under UnitedHealthcare's own payer ID 87726 — the SAME ID as medical claims, not a separate behavioral-health-specific ID (contrast Simply/Carelon, which fully carves both auth AND claims to a distinct entity). These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.
- **97152, 97156, 97158:** These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.
- **97153:** Billed at the SAME $12.26/unit rate whether rendered by an RBT, BCaBA, or Lead Analyst — Florida does not tier 97153 by staff credential (contrast 97155/97156, which do via the HN modifier). These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.
- **97154:** The modifier documents group size, not staff credential — rate scales DOWN as the group grows. These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.
- **97155:** Rendered by Lead Analyst or BCaBA only — RBTs do not bill 97155 in Florida. These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.
- **97157:** If a family reports a Florida plan authorizing/paying 97157, verify directly with that plan — it would be an accommodation outside the state fee schedule, not the documented default. These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.
- **0362T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior assessment support; billed alongside 97151/97151-TS, not standalone. These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.
- **0373T:** Requires an on-site physician/QHP plus 2+ technicians for severe/destructive-behavior exposure treatment; billed alongside 97153/97155. These are the statewide AHCA BA Coverage Policy mechanics, binding on UnitedHealthcare Community Plan of Florida (Optum-managed) per the policy's plan-compliance clause (§1.2); UnitedHealthcare Community Plan of Florida (Optum-managed)'s own documents don't restate full code-level unit-cap/POS detail beyond what's marked 'verified' above — confirm any 'inferred' field with UnitedHealthcare Community Plan of Florida (Optum-managed) provider relations before quoting a family.

### Contacts

- **Provider services phone:** 1-877-614-0484
- **Phone menu path:** Provider Express Web Support Center (portal help): 1-866-209-9320. EDI/claims support: 1-800-210-8315 or ac_edi_ops@uhc.com.
- **Portal:** [Provider Express](https://public.providerexpress.com/)

Questions to ask on a verification call:

- What payer ID should we use for pVerify and Change Healthcare eligibility checks, and do you support 270/271 real-time eligibility — or is BA eligibility portal/phone-only, as your own QRG suggests?
- Which service-type code do you return ABA benefit details under?
- Does the deductible apply to ABA, and is the cost share a copay or coinsurance?
- Is any copay charged per visit or per day, and does the out-of-pocket max apply to ABA?
- What’s the cap period for 0373T?

### VOB data sources

- https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/fl/resources/FL-BAP-QRG.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/flaba/FLABAQRG.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/COMPANION%20GUIDES/FMMIS_5010_270_271_Companion%20Guide_v4_0_04272023.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf (accessed 2026-07-23)
- https://ahca.myflorida.com/content/download/26138/file/2025%20Behavior%20Analysis%20Fee%20Schedule.pdf (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare Community Plan of Florida cover ABA?

Yes — since February 1, 2025 its Behavior Analysis program is managed by Optum on the state clinical criteria: no autism diagnosis required, physician referral + order + CDE, PA on all BA services.

### How do I submit a BA authorization to UHC Community Plan of Florida?

Portal-only: Provider Express → Auths → Request a new authorization → "ABA Assessment" or "ABA Treatment." No fax pathway is advertised for BA — unique among Florida's nine plans.

### Where do UHC Florida Medicaid ABA claims go?

To UHC Community Plan, payer ID 87726, within 180-day timely filing; clean claims process in 15 calendar days. First-time submitters must attach a W9 and a copy of the Florida license.

## Primary sources

1. [UHC Community Plan FL — SMMC Behavioral Analysis Program QRG (BH00998-1-25)](https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/fl/resources/FL-BAP-QRG.pdf)
2. [Optum Provider Express — Florida ABA QRG](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/flaba/FLABAQRG.pdf)
3. [Florida Medicaid BA Services Coverage Policy (Dec 2024)](https://www.flrules.org/gateway/readRefFile.asp?refId=17525&filename=Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf)
4. [UnitedHealthcare Community Plan — 2026 Care Provider Manual, Florida LTC and MMA](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/FL-Care-Provider-Manual-Statewide-Medicaid-Managed-Care.pdf)
5. [AHCA SMMC Model Health Plan Contract — Attachment II Core Provisions (update 10/1/2025), §V.6 and §XI.D](https://ahca.myflorida.com/content/download/27248/file/Attachment%20II-%20-%20Core%20Contract%20Provisions%20Oct%202025.pdf)
6. [Rule 59G-1.052, F.A.C. — Third-Party Liability Requirements (AHCA)](https://ahca.myflorida.com/content/download/5929/file/59G_1052_TPL_Requirements.pdf?version=1)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.